Timeline

A QHC PECMH explainer

Each time QHC runs into financial difficulty, the pain is felt disproportionately in Prince Edward County Memorial and Trenton Memorial hospitals. Our coverage tends to pick up on the most recent issues, but readers have asked for a brief synopsis of the story until now. Here is our summary, presented in two parts: Fading accountibility and A shrinking hospital.

The fate of the community hospital in Picton, Prince Edward County Memorial Hospital (PECMH), has been intertwined with that of Quinte Health Care, its administrators and board since 1998. That year, the provincially appointed Health Care Restructuring Committee, led by former deputy health minister Graham Scott, compelled PECMH, over protests by its governors and a great many in this community, to join with Belleville General Hospital (BGH), Trenton Memorial (TMH), and North Hastings Hospital (NHH). Since then, the steady and disproportionate erosion of services and capacity at PECMH in pursuit of the financial health of the amalgamated corporation has generated near constant turmoil and public outrage in this community.

ACCOUNTABILITY SLIPS AWAY
That turmoil was reflected on QHC’s board and its activities. When it was formed in 1998, and until 2009, QHC directors were elected by members. Ordinary citizens could purchase a membership, nominate directors and vote on their election and decisions at QHC’s annual general and special meetings.

To be elected, it was necessary for prospective directors to be visible and answerable to the community. Once elected, directors acted as the communication link between QHC and their community. Citizens knew who represented them and how to reach them with concerns.

In 2006, consultant Scott Rowand advised QHC, among other suggestions, this form of representation was too open and too democratic to govern the hospital effectively. Rowand’s report would become the blueprint for many of changes that would reshape QHC.

In 2009, the Ontario Ministry of Health and Long Term Care, unhappy with the progress of integration, consistently bad press, community discontent and QHC’s inability to balance its budget, decided, for the fourth time in a decade, to intervene in the affairs of this hospital. A supervisor, once again Graham Scott, was appointed take over the hospital. The first thing he did was to can the QHC board. Three regional mayors including Leo Finnegan—mayor of Prince Edward County at the time—sitting as ex officio members, were also dismissed from their role in advising QHC. The membership was also dissolved.

When a new board was established in June 2009, it was chosen by a Community Advisory Council, made up of six individuals hand-picked by Scott. The membership structure was replaced by an advisory group of 54 residents in the QHC catchment area as prescribed by Scott’s six member panel. It mirrored recommendations made by Rowand three years earlier. The new advisory council could make recommendations, but no longer had a vote on who sat on the board or on key decisions of the hospital corporation. Ordinary citizens were effectively shut out of the direct access to the governance of the hospital.

THE SHRINKING HOSPITAL
In 1998, there were 42 beds at PECMH—today there are just 12, as few as 10 at certain times of the year.

By 2005, PECMH had been cut down to 24 medical beds. That year, QHC CEO Bruce Laughton had to find $4.8 million.

“There are no more rabbits left to pull out of the hat,” said Laughton. “We’ve taken $12.8 million out of operations over the last four years.”

Nevertheless, he proposed eliminating critical care beds, day surgery and the diagnostic lab from the Picton hospital. In September that year, more than 1,000 County residents filled the Community Centre in Picton to protest the proposed cuts to PECMH.

QHC withdrew the proposed cuts, citing public protests, and instead submitted an unbalanced budget.

In February 2006 QHC launched a fundraising campaign for new diagnostic equipment. Finnegan sought assurances that if the municipality was contributing to the campaign there would be no more cuts to services at PECMH. Campaign chair Lyle Vanclief warned Finnegan, “just remember, if the support of the hospital isn’t there, we put its future in jeopardy.”

No assurances were forthcoming. Nevertheless, the municipality agreed to contribute its share to the campaign.

In June 2006, then-Ontario Health Minister George Smitherman came to Picton, presenting money to repair the emergency department and develop a new master plan. He warned that this community would likely soon lose maternity care, for the sake of the safety of “mom and baby”. That sparked an extensive review by physicians in this community—the literature didn’t support the health minister’s claim— there was and remains no evidence to indicate low volumes equals poorer outcomes.

Smitherman also released Rowand’s longawaited report, New beginnings, describing what he saw as a dysfunctional board along with his perception of the unrealistic expectations and the destructive parochialism of the residents, doctors and QHC directors from Prince Edward County, factors he said hindered the four hospitals from effectively integrating.

In the spring of 2007, QHC attempted to sidestep the increasingly vocal membership by proposing a slate of candidates that could only be voted up or down. There would be no open nominations.

The hospital corporation eventually backed away from that plan. But the financial bleeding continued. Neither Rowand’s recommendations nor measures taken by QHC to separate the community from the corporation had managed to fix the overspending.

By 2008, the projected deficit was $12 million on a budget that was now burning through $160 million a year. QHC’s Laughton proposed a range of options to cut costs. It would mean cutting two more beds in Picton—but endoscopy services would be consolidated at PECMH.

In a public meeting that month in Picton, more than 600 residents were turned away, including, for a time, then MPP Leona Dombrowsky.

In 2009, QHC was facing a $15 million shortfall. It submitted a budget with a $4 million hole in it. The newly established Local Health Integration Network (LHIN) rejected the proposal.

Graham Scott was appointed as supervisor. The board and membership were dismissed.

In March 2010, Mary Clare Egberts took over the top job at QHC. Before he left, Scott had secured a one-time expansion of the hospital corporation’s budget.

In January 2011, Egberts announced she was cutting three beds in Picton.

“I am absolutely committed to fighting for this hospital,” said Egberts. “I am committed to creating a model of care in the County that will be a model for the province in which we can provide care in a safe way close to home in rural communities.”

The following spring, QHC announced plans to develop a new hospital in Picton.

But in January 2013, Egberts said nine beds would be cut from PECMH over three years. Obstetric care—long in the sights of cost cutting consultants— was also eliminated.

“The vision for a vibrant new hospital in Picton is more relevant today than it has ever been,” said Egberts.

Currently, QHC is projecting a $12 million deficit on a budget of more than $192 million.